First Day Back to Work

Today is post-surgery #1 day number 16 and my first day back to work. Everything went very well except I hit the wall energy-wise around two o'clock in the afternoon. Plus I definitely feel it in my jaw tonight ... I did quite a bit more talking today than any other day up to this point.

I'm so glad tomorrow is Friday so I'll have the weekend to recover and prepare for next week's surgery.

Weight Just a Minute

Two weeks post-surgery #1 and I've dropped just over 10 pounds. While I wouldn't advocate jaw surgery as a diet, it sure does work.

Speaking of jaw surgery and diets, Delag (a contributor over at the Archwired web-site) found a really good web-site dedicated to those people who have their jaws wired / banded for whatever reason. The web-site is called *8 Weeks Wired* and offers advice on such topics as pre & post surgery care, nutrition, recipes, supplies, et cetera. I haven't had a chance to go through the whole web-site yet ... will do that prior to next week's surgery.

Surgery -- Round #2

Well, had my follow-up this morning and the Surgeons determined that the open bite caused by my surgery a couple of weeks ago can't be corrected with elastic bands or further work by the Orthodontist. They said that the most likely cause is "hardware failure" ... a problem with the titanium plate and/or screws. While I think that's possible I think it's just as likely that the Surgeon secured the titanium plates in the wrong position.

So, I now have another surgery date for Tuesday, 3 April 2007 and get to go through this whole process again. Yay me!!!

The Surgeons will be using the same incisions as before and will remove the current hardware, reposition the lower jaw, and then attach new hardware. The main differences this time is that the bones haven't had time yet to reattach fully so it'll be easier to dislocate the lower jaw and the chin augmentation surgery has already been done so I don't have to worry about that.

Now it's time for me to go grab a couple of Coronas and see if I can't figure out how to make myself a cheesecake milk shake.

So Here's the Latest - 23 March 2007

To recap ... the day after the surgery (Wednesday, 14 March 2007) the Surgeons decided to use tight elastic bands because it appeared that my jaw muscles wanted to "pull" my lower jaw into a different position than the one it should be in.

This past Wednesday I had my first post-surgery appointment with the Surgeons. During the appointment they removed the elastics and, I kid you not, I literally felt my lower jaw drop open. It was kind of like the slack-jawed response you sometimes see people give when they've witnessed something they just can't believe. I'd say it was no more than 1/4 inch or so, no pain, no problems whatsoever. It just surprised me a tad and made me want to hold my lower jaw closed with a free hand for a bit until I was sure the blasted thing worked properly.

As I said previously, the Surgeon said they were going not going to replace the elastics because they wanted to see if the bite held the correct position without them ... she said that was their normal method although almost all of the other post-surgery accounts I've come across this is not done. They took more digital x-rays, set me up with an appointment for the following Wednesday (I've got a standing appointment every Wednesday for six weeks post-surgery) and I was on my way.

Well, it took less than one day for the lower jaw to move back into the same position it was in the first morning after surgery. Now, both the upper and lower mid-lines are in alignment with each other, the lower jaw appears to be in the correct position relative to the upper jaw ... the only thing is that the only teeth currently touching are one or two molars (hard to say how many due to the residual swelling) on the right side. I called the Surgeon Thursday morning (22 March 2007) and they set me up for an appointment first thing this morning (Friday, 23 March 2007).

So I leave the house at 5:30 this morning, two hours early due to the notoriously bad Northern Virginia / Washington DC traffic, and wouldn't you know it, there wasn't any traffic! I actually arrived at the hospital right around 6:15 am. I'd rather be early than late but my appointment wasn't until 7:30 am. I was in time, however, to speak with one of yesterday's surgery patients who was getting his morning after check-up / x-rays ... well, I did the speaking and he, because he had both upper and lower jaw surgery, just kinda looked at me. I told him to hang in there, that it was all down hill from here, that the swelling and discomfort were all temporary, and that it would all be behind him before he knew it.

I finally get in to see the Surgeon and, after a bit of consultation with the Chief Surgeon, they decided to take more x-rays and leave the elastic bands off for the weekend. I do, however, have another appointment Monday morning (26 March 2007) and this time I expect it'll be a meeting between me, the Surgeons and the Orthodontist (he's co-located in the same area in the hospital) in order to determine exactly what is going on and the best course(s) of action to take.

So here's what I think may be the issue:

1) My jaw muscles need to be "retrained" and I'll go back into elastics on Monday; or,

2) My lower jaw is in the proper position and the orthodontist (once he's been given the go-ahead to continue treatment) will do his magic to realign the possibly wayward molar(s); or,

3) *this one really concerns me* The Surgeons may have incorrectly decided I didn't need to have the upper jaw surgery and will now have to go back and widen the upper jaw (either with a SARPE device or a Lefort I procedure). I imagine the Orthodontist might be able to still realign the molars if this is the case so maybe surgery won't be needed.

On a positive note -- I can now drink liquids using a regular glass. I'll hang on to the Zip-N-Squeeze bags for now though ... just in case.

One Week Post Surgery Update

Okay, it's been exactly one week since I was released from the Hospital after having both lower jaw surgery and genioplasty (chin surgery). Up to now I have been very tightly banded with elastic bands and have been on a blended/liquids only diet.


Well, today the Surgeons decided to remove the bands to see how the jaws align without the added structure. The lead Surgeon's usual course of action for lower jaw surgery is to forego the elastics as long as the jaws remain in the desired position. I have another post surgery appointment next Wednesday (28 March) and they will decide then whether or not I need to go back into elastics. Here's hoping I don't but I think I just might have to ... we'll see. And I'm still on the blended/liquids only diet.

Below are comparison photos of a couple of days before the surgery and today. Both photos are showing my "natural" bite at the time of the photo.

11 March 2007

21 March 2007

Aarrgghh

Finally got to sleep about 3:00 am this morning and almost immediately had the following dream.

I was at the beach when all of a sudden the sand started hardening like cement around my head. I was struggling to breathe and could only barely breathe through my mouth ... my nose was completely closed.

I woke up thrashing around and realized that I was attempting to breathe through my mouth which continues to be very tightly banded closed.

My next post-surgery appointment is tomorrow. Here's hoping they replace the current bands with ones that aren't quite as tight.

The Rainbow Passage

I found the below over at the Archwired community web-site. One of it's regular contributors, KiwiKaren, says that reciting the Rainbow Passage supposedly helps jaw surgery patients relearn how to make the proper sounds associated with "normal" speech. This is important because slight speech impediments occur ("s" turns into "sh", etc...) due to the repositioning of the jaw muscles.

The Rainbow Passage

When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond his reach, his friends say he is looking for the pot of gold at the end of the rainbow.

Sunday Updates (18 March)

A few more photos to laugh about:

Saturday - 4 days post surgery

My Sister Alice (far right with white shirt and green beads) is staying with me until tomorrow when she'll be flying back to Biloxi, MS. She had made plans to celebrate St Patrick's day with a couple of friends of hers in the area. As you can see, I didn't know that she was going to invite them over for a few minutes so they could consolidate cars. Had I known I might (just might) have put on my green pajamas. Especially because Sharon (2nd from right with green shirt and green beads) gave me a little mutated chicken / bunny critter to help me feel better.

Mutated Chicken / Bunny Critter

On Sunday I decided to venture out of the house and go to the local Borders Book Store. As you can hopefully see from the below photo, the bruising down my neck has gotten a very nice shade of yellow.

Sunday - 5 days post surgery

Walking around Borders was quite uneventful. Even the little kids didn't stop and stare too much when they saw me ... I'll have to try harder when I go to the grocery store next week. Just like a couple of days ago, however, I started feeling the swelling pick up almost as soon as I walked out the door. I didn't feel poorly ... just tired out awful quickly. Luckily I'll be off work until Thursday, 29 March so I can work on getting my stamina back up.

Wednesday - Saturday Updates

Let's start with a few more photos.

Thursday - 2 days post surgery

Friday - 3 days post surgery

I mentioned previously that the recovery wasn't going as well as I had hoped it would. My main two problems have been sleeping in an inclined position (rather than on my side) and breathing issues.

Of the two, I'd have to say the one that had me the most worried was breathing. I had always had an open bite that resulted in my breathing through my mouth when I slept. And I've never had the best of times when breathing through my nose due to various reasons.

After the surgery I was heavily banded which prevented me from opening my mouth at all and, of course, the swelling was having an effect on how well I could breath. This led me Wednesday night to experience a slight panic attack when it felt like I wasn't getting enough air throughout the night. Nothing too much ... I didn't go running around looking for the scissors or anything to cut the bands. But I did spend a rather large percentage of my time just concentrating on getting full deep breaths through my nose for most of the night. And it wasn't an issue where the nasal passages were clogged ... they weren't. I had used Afrin earlier that day and had followed that up with Ocean's Nasal Spray closer to bed time. It just felt like I was laboring way too hard for each breath.

The other breathing issue that just occurred over the last day/night is that I'm creating a whole lot of saliva that requires me to constantly swallow throughout the night. At times this has caused me to startle awake thinking I was drowning. Not a pleasant sensation.

Other than that, though, things have been progressing along nicely. The swelling is starting to subside, I'm putting down more liquids each day (water, Boost, banana shakes) thanks to the Zip-N-Squeeze bags, and my energy levels are starting to slowly increase.

I may have pushed it too far yesterday though. I was getting a little bit stir crazy in the apartment and asked my Sister to drive me to my office so I could show off my swelling to my co-workers (they're Marines ... they like this kind of stuff). It's about a 30 minute drive each way with minimal walking (some stairs) inside the building. I'll tell you I could feel the swelling increase just from walking out and climbing into the car ... much less walking up the stairs at work. After we returned home I was done for the day.

Today (Saturda, 4 days post surgery) the swelling seems to be subsiding a bit. It does, however, increase throughout the day. And I'm turning a nice shade of yellow down my neck, past my collar bones, and onto my chest. I'll see if I can't get a good photo of that for later.

On the Other Side!

Well, the surgery's over and it's time to post a little update. While I didn't have an adverse reaction from the anethesia, it's not been as easy a recovery as I had hoped. Of course, it's only three days post-op so things can only get better from here on out.

My sister, Alice, flew out this past Saturday to stay with me for a bit. As it turns out, she had a gastrointestinal bug Sunday, Monday and Tuesday. She ended up sleeping much of that time and I tried not to catch what she had ... didn't want to get sick and have to cancel the operation. She ended up calling her Doctor and getting a prescription - seems to be all better now.

We stayed at a Marriott hotel about 13 miles from the hospital. I don't live too far from the hospital (about 35 to 40 miles) but I do live in the Northern Virginia / Washington, DC area and if you've ever been here then you know how the traffic can get. Doesn't matter what time of the day it is ... traffic is BAD. This worked out well as my show time was 5:30 am Tuesday morning for a 7:30 am surgery time.

Turns out there are 14 operating rooms in the hospital so the pre-surgery drill was in a "group" environment. All of us patients were there for different reasons and each of us had our own operating room staff (surgeons, anethesiologist, et cetera.) ... we were just kept in a central area until it was our turn to head into the operating room.

I completed all of the pre-surgery stuff with the anethesiologist and, before you know it, they had hooked up my IV drip with the stuff that calms you down -- that's some GOOD stuff! About 15 minutes later I was in the surgery room and the anethesiologist had the breathing mask over my face telling me to breathe deeply ... about four breaths later I was out. The last thing I remember was them pulling down my pajama bottoms for what I'm hoping was a catheter and then waking up in my hospital room. I don't remember the recovery room at all.

I guess I "woke up" for good right around 2:00 pm. From what I was told I was in surgery for about four hours (lower jaw surgery (BSSO) and chin augmentation (genioplasty)) and in the recovery room for about one and one half hours. They ended up "de-rotating" my lower jaw four to five millimeters to the right and back just a smidgen (my term) and augmenting my chin by bringing it out about eight millimeters. It's amazing, really, when you consider that all of this was done INSIDE my mouth with the exception of two tiny incisions (one on each side of my jaw) so they could place the titanium screws in the proper places.

The afternoon of the surgery I felt amazingly well ... really, really good. I found out later that I still had quite a bit of the anethesia in me as well as pain meds (morphine anyone) and steroids (for the swelling). I was drinking water like a fish and was able to go to the restroom on my own well before dark. I was able to speak relatively easily as my surgeons had not placed very strong bands on me after the surgery. Wednesday morning I had x-rays taken and tighter bands placed which have caused me a bit of discomfort (muscles really do have a "memory" and my lower jaw muscles want to try and get back into their previously "normal" position).

My sister showed up around 11:00 am on Wednesday, we picked up my medication, and I got home I think around 2:00 pm Wednesday afternoon. I'll go into "home time" in a later post. For now, below are some pictures from after the surgery while still at the hospital:

First Picture After Waking Up

The Swelling is Still Down

Using the Hospital Syringe for Drinking Water

That's it for now ... I'll post more tomorrow on what it's been like at home / away from the hospital.

Show Time

Just returned from one last teeth cleaning visit. That was a bit interesting considering all the metal I have in my mouth.

I confirmed the surgery time with the Hospital ... 7:30 am. That means I'll be checking in to the hospital at 5:30 am.

With that check-in time they just might not need to give me any anesthesia.

How to Post a Comment

For my computer-challenged family (you know who you are) ...

1) Click on "Comment" at the bottom of each post.

2) Type your comments in the "Comment Box".

3) When you're finished scroll down to the bottom of the "Comment Box" and choose the "Other" identity option.

4) Type your name in the "Name Box".

5) Click "Publish".

Preoperative Instruction Sheet

Here's what my preoperative instruction sheet says:

-Wear comfortable clothing suitable to the type of surgery you are having.
-DO NOT bring any valuables or wear any jewelry.
-Please do not wear make-up, contact lenses, or fingernail polish.
-Please remove ALL body piercing.
-Dentures and eyeglasses must be removed before going to the Operating Room.

Females - If you have been given a urine specimen container, obtain a urine sample at home on the morning of your procedure and bring it with you to the Ambulatory Procedures Unit (APU)/Short Stay Unit (SSU). It will be collected when you check in at the APU Nurse's Station.

Children are to wear their pajamas and may bring a favorite toy.

MEDICATIONS - do not take any aspirin-containing or Motrin-like medication (including over-the-counter) for two weeks prior to and two weeks after your surgery unless otherwise directed by your physician. These medications include but are not limited to: Aspirin, Excedrin, bufferin, Anacin, Cama, Alka Seltzer, Motrin (Ibuprofen), Indocin, Tolectin, ClinorU (Sulindac), Naprosyn, Toradol, Advil, Nuprin, Aspergum, Vioxx, Naproxen, Celebrex, Diclofenac, mobic (Meloxicam), Bextra.

Do not take the following herbal products - Gingko biloba, Garlic, Ginger. These can prevent blood clots from forming and have been associated with prolonged bleeding.

Do not take Vitamin E supplements.

TYLENOL IS OK. IF ONE OF THE ABOVE MEDICATIONS OR HERBAL SUPPLEMENTS IS TAKEN, YOUR SURGERY MAY BE DELAYED OR CANCELLED.

DO NOT EAT anything solid after midnight on: 12 March.
DO NOT DRINK anything after midnight on: 12 March.

If ordered by your surgeon, you may drink clear liquids up to the time you check in at the APU. Once you check in nothing else may be taken by mouth except prescribed medications with sips of water. Clear liquids include water and coffee without milk.
Only drink the liquids on this list. Orange juice is NOT permitted.
DO NOT DRINK ANY ALCOHOLIC BEVERAGES WITHIN THE 24 HOURS PRIOR TO YOUR SURGERY!

Other items for consideration on your day of surgery (as applicable):
- Complete surgical scrubs as directed with Betadine/Hibiclens/Ivory/regular soap (the night before and the morning of surgery).
- If you require inhalers please bring them with you.
- If you utilize a CPAP machine please bring it with you.
- Bring a copy of your Advanced Directive, Living Will, Five Wishes, or Power of Attorney.

Meals on the Short Stay Unit (SSU) (Overnight Patients)

One you return to the SSU after your procedure, you will be offered the option to receive meals from the Nutrition Management Department via the National Naval Medical Center billing system.

Cost per meal: Breakfast - $1.70 Lunch - $3.30 Dinner - $3.30

Apple juice, ginger ale, gelatin, popsicles, broth, ice cream, and crackers will be available for in-between meal snacks. Your family may also bring you meals, as there are several fast food alternatives available in the hospital.

Holy Metal Batman!

In case you don't know, the surgeons will band my jaws shut using either wire ties or strong rubber bands. They'll do this with the help of "surgical hooks."

Yesterday I went to the Orthodontist to have the surgical hooks installed on my archwires. I had this idea that I'd get a couple of them on each side of the upper and lower jaws ... maybe eight in total.

Boy was I wrong!

I've got 18 of those things (nine on top and nine on the bottom) ... basically, one in the middle of each of the brackets. The good thing is that, at lease so far, they aren't bothering me in the slightest. Not even when I eat - a very nice surprise. In fact, my mouth doesn't feel any different at all with these things installed.

I did manage to get my shirt caught on the upper surgical hooks (don't ask me how). Had to go get a mirror to get it loose.

Yeah, I'm talented like that.

One week to go!

Okay, this time next week I'll either look like Brad Pitt or Rodney Dangerfield. I'm secretly hoping for Rodney because, let's face it, looking like Brad would just be too much pressure!

I've done a ton of research so I have a pretty good idea on what to expect. I'm not stressing ... actually looking forward to it being over. The only thing still up in the air is whether I'll be having upper and lower jaw surgery along with genioplasty or just the lower jaw surgery and genioplasty. I'll find out for sure this Friday when I get the surgical hooks.

I'm *NOT* looking forward to that.